The Ross procedure: Is it the ideal operation for the young with aortic valve disease?

BACKGROUND: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and normalize left ventricular function. This possibly affects long-term prognosis after aortic valve replacement. OBJECTIVE: Assessment of hemodynamic performance of pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure. METHODS: Between May 1995 and March 1996, 45 patients with mean age of 27.1 years underwent a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to evaluate the hemodynamic performance of auto- and homografts, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were submitted to dobutamine stress echocardiography to study the hemodynamic performance of auto- and homografts during exercise. RESULTS: Hospital mortality was 6%. After a mean follow-up of 12.8 months (1-23 months) there was one late sudden death. No valve-related event was observed during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with an average mean gradient of 1.8 +/- 0.6 mmHg and an average maximum instantaneous gradient of 2.9 +/- 0.9 mmHg. Valvular insufficiency was insignificant. Even during exercise, gradients did not increase significantly with an average mean gradient of 4.3 +/- 2.5 mmHg and an average maximum gradient of 10.4 +/- 6.1 mmHg. Homografts used for right ventricular reconstruction showed excellent immediate hemodynamic performance. However, at late follow-up an increase in flow speed was observed with an average to mean gradient of 10 +/- 7.1 mmHg at rest and 26 +/- 13.2 mmHg during exercise. Left ventricular mass index was normal at rest and during exercise in the majority of patients. CONCLUSION: Given the normal hemodynamic function of pulmonary autografts, the reduction of ventricular mass and normalization of left ventricular function, in addition to the excellent late follow-up of the patients, the Ross procedure is considered the operation of choice for young patients requiring aortic valve replacement.

[Aortic valve replacement with pulmonary autograft (Ross procedure). Initial experience]. / Substituição da valva aórtica com auto-enxerto pulmonar (cirurgia de Ross). Experiência inicial.

PURPOSE: Report the initial surgical experience with four cases utilizing a pulmonary autograft for aortic valve replacement. METHODS: Four patients, all males, white, age between 23 and 46 years having aortic valve disease were submitted to aortic valve replacement with a pulmonary autograft using the root replacement technique. Right ventricular outflow tracts were reconstructed with antibiotic sterilized pulmonary or aortic homografts. All patients had control bidimensional eco-doppler (ECO) and hemodynamic study to evaluate the function of the implanted auto and homografts. RESULTS: All patients had an excellent post-operative recovery, without the necessity of inotropic drugs. All presented in normal sinus rhythm. Post-operative ECO and hemodynamic studies revealed excellent function of the implanted autografts, without gradients in three and with a 15mmHg mean residual gradient in one case. There was no regurgitation in three cases and only trace aortic insufficiency in one. The right sided homografts also showed good function, with no gradient in two cases and mean systolic gradient of 6 and 8mmHg in the other two. CONCLUSION: The pulmonary autograft procedure should be implemented definitely in our country.

Substituição da valva aórtica com auto-enxerto pulmonar (cirurgia de Ross). Experiência inicial / Aortic valve replacement with pulmonary autograft (Ross procedure). Initial experience

Objetivo - Relatar a experiência cirúrgica inicial de 4 casos com a utilizaçäo do auto-enxerto pulmonar para substituiçäo da valva aórtica. Métodos - Quatro pacientes masculinos, brancos, com idades entre 23 e 46 anos, portadoras de valvopatia aórtica, forma submetidos a substituiçäo da valva aórtica pelo auto-enxerto pulmonar pela técnica de substituiçäo total da raiz aórtica. Para a reconstituiçäo da via de saída do ventrículo direito foram utilizados homo-enxertos pulmonares e aórtico conservad em soluçäo de antibióticos. Todos tiveram controle pós-operatório com eco-doppler (ECO) e estudo hemodinâmica para a avaliaçäo da funçäo dos auto e homo-enxertos implantados. Resultados - Todos apresentaram excelentes evoluçäo pós-operatória, sem necessidade de drogas inotrópicas e em ritmo sinusal. Os resultados obtidos através do ECO e estudo hemodinâmico revelaram excelente fuçäo dos auto-enxertos implantados sem gradiente em 3 casos e gradiente médio residual de 15 mmHg em um. Näo se observou reguriaçäo aórtica em 3 casos e insuficiência leve no 4o. ano. Os homo-enxertos implantados no lado direito do coraçäo apresentaram excelentes funcäo, sem gradiente em 2 anos e gradiente médio de 6 e 8 mmHg nos outros dois. Conclusäo - A cirurgia do auto-enxerto pulmonar deve ser implantada de forma definitiva em nosso meio

Purpose - Report the initial surgical experience with four cases utilizing a pulmonary autograft for aortic valve replacement Methods - Four patients, all males, white, age between 23 and 46 years having aortic valve disease were submitted to aortic valve replacement with a pulmonary autograft using the root replacement technique. Right ventricular out flow tracts were reconstructed with antibiotic sterilized pulmonary or aortic homografts. All patients had control bidimensional eco-doppler (ECO) and hemodynamic study to evaluate the function of the implanted auto and homografts. Results - All patients had an excelent postoperative recovery, without the necessity of inotropic drugs. All presented in normal sinus rhythm. Postoperative ECO and hemodynamic studies revealed excelent function of the implanted autografts, without gradients in three and with a 15mmHg mean residual gradient in one case. There was no regurgitation in three cases and only trace aortic insufficiency in one. The right sided homografts also showed good function, with no gradient in two cases and mean systolic gradient of 6 and 8mmHg in the other two. Conclusion - The pulmonary autograft procedure should be implemented definitelly in our country